RESUMO
INTRODUÇÃO: A Síndrome de Fournier consiste em uma fasciite necrosante que afeta tecido subcutâneo e pele do períneo e genitais externos. Caracterizada como uma urgência cirúrgica, seu tratamento é baseado em três pilares: debridamento de tecidos necróticos e infectados; controle sistêmico e antibioticoterapia; e reparação dos tecidos afetados. OBJETIVO: Identificar o perfil clínico de pacientes diagnosticados com Síndrome de Fournier em um hospital de urgências. MÉTODOS: Trata-se de um estudo descritivo, retrospectivo e de abordagem quantitativa. A amostra consistiu de pacientes diagnosticados com Síndrome de Fournier acompanhados pela comissão de curativos do hospital no período de agosto de 2016 a agosto de 2017, que receberam alta ou foram a óbito. RESULTADOS: A amostra do estudo foi composta por 14 pacientes, sendo em sua totalidade pacientes do sexo masculino, entre 21 e 82 anos e idade média de 55 anos. Em 50% dos casos, foi necessário internação em Unidade de Terapia Intensiva (UTI). Quanto ao desfecho, 78,6% (11) receberam alta hospitalar e 21,4% (3) evoluíram para óbito. CONCLUSÃO: A assistência a pacientes com Síndrome de Fournier ocorre de forma despadronizada, o que ocasiona altas taxas de mortalidade. A elaboração de protocolos específicos é necessária.
INTRODUCTION: Fournier's Syndrome consists of a necrotizing fasciitis that affects subcutaneous tissue and skin of the perineum and external genitalia. Characterized as a urological urgency, its treatment is based on three pillars: debridement of necrotic and infected tissues; systemic control and antibiotic therapy; and repair of the affected tissues. OBJECTIVE: To identify the clinical profile of patients diagnosed with Fournier's Syndrome in an emergency hospital. METHODS: This is a descriptive, retrospective and quantitative study. The sample consisted of patients diagnosed with Fournier's Syndrome and attended by the hospital curative committee from August 2016 to August 2017, who were discharged or died. RESULTS: The study sample consisted of 14 medical records, all of them were male, aged between 21 and 82 years and mean age of 55 years. In 50% of the cases admittance to the Intensive Care Unit (ICU) was necessary. Regarding the outcome, 78.6% (11) were discharged from hospital and 21.4% (3) died. CONCLUSION: Assistance to patients with Fournier Syndrome is poorly standardized, resulting in high mortality rates. Development of specific protocols is necessary.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pênis/lesões , Lesões dos Tecidos Moles , Gangrena de Fournier , Fasciite Necrosante , Pênis/patologia , Infecções do Sistema Genital/complicações , Infecções do Sistema Genital/patologiaRESUMO
Chlamydia trachomatis is the most prevalent sexually transmitted bacterial infection. However, whether Chlamydia trachomatis has a negative impact on sperm quality and male fertility is still controversial. Herein, we report the effects on sperm quality of the in vitro exposure of spermatozoa to Chlamydia trachomatis, and also the effects of male genital infection on male fertility using an animal model. Human and mouse sperm were obtained from healthy donors and cauda epididimys from C57BL/6 mice, respectively. Highly motile human or mouse spermatozoa were in vitro exposed to C. trachomatis (serovar E or LGV) or C. muridarum, respectively. Then, sperm quality parameters were analyzed. Moreover, male fertility of Chlamydia muridarum infected male C57BL/6 mice was assessed. Human or murine sperm in vitro exposed to increasing bacterial concentrations or soluble factors from C. trachomatis or C. muridarum, respectively, did not show differences in sperm motility and viability, apoptosis, mitochondrial membrane potential, DNA fragmentation, ROS production and lipid peroxidation levels, when compared with control sperm (p > 0.05). Moreover, no differences in fertility parameters (potency, fecundity, fertility index, pre- and post-implantation loss) were observed between control and infected males. In conclusion, our results indicate that Chlamydia spp. neither directly exerts deleterious effects on spermatozoa nor impairs male fertility.
Assuntos
Infecções por Chlamydia/complicações , Infecções por Chlamydia/patologia , Chlamydia trachomatis/patogenicidade , Fertilidade , Infecções do Sistema Genital/complicações , Infecções do Sistema Genital/patologia , Espermatozoides/fisiologia , Animais , Movimento Celular , Sobrevivência Celular , Chlamydia muridarum/patogenicidade , Modelos Animais de Doenças , Humanos , Peroxidação de Lipídeos , Masculino , Camundongos Endogâmicos C57BL , Espécies Reativas de Oxigênio/metabolismoAssuntos
Micetoma/diagnóstico por imagem , Nocardiose/diagnóstico por imagem , Nocardia/isolamento & purificação , Ovário/diagnóstico por imagem , Doença Inflamatória Pélvica/diagnóstico por imagem , Infecções do Sistema Genital/diagnóstico por imagem , Dor Aguda/etiologia , Dor Aguda/prevenção & controle , Adulto , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Dor nas Costas/etiologia , Dor nas Costas/prevenção & controle , Diagnóstico Diferencial , Monitoramento de Medicamentos , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Micetoma/tratamento farmacológico , Micetoma/microbiologia , Micetoma/patologia , Nocardia/efeitos dos fármacos , Nocardiose/tratamento farmacológico , Nocardiose/microbiologia , Nocardiose/patologia , Ovário/efeitos dos fármacos , Ovário/microbiologia , Ovário/patologia , Doença Inflamatória Pélvica/tratamento farmacológico , Doença Inflamatória Pélvica/microbiologia , Doença Inflamatória Pélvica/patologia , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Infecções do Sistema Genital/tratamento farmacológico , Infecções do Sistema Genital/microbiologia , Infecções do Sistema Genital/patologia , Resultado do Tratamento , Redução de Peso , Adulto JovemRESUMO
El virus del papiloma humano (VPH) es una de las enfermedades de transmisión sexual más comunes. Puede afectar tanto el aparato genital masculino y femenino, como también el área perianal, ano, y diversas áreas de cabeza y cuello y otorrinolaringológicas, ya sea como lesiones benignas o como promotor de lesiones malignas. Las lesiones benignas por VPH en genitales masculinos se caracterizan fundamentalmente por la aparición de lesiones verrugosas, aunque también puede manifestarse mediante lesiones planas atípicas. En algunos casos hay ausencia de lesiones macroscópicamente visibles que pueden hacerse evidentes con la prueba de ácido acético. La biopsia de la lesión, su evaluación anatomopatológica y, sobre todo, la determinación de la existencia y el tipo de virus involucrado mediante PCR (reacción en cadena de la polimerasa) permiten confirmar el diagnóstico. En algunas ocasiones es necesario realizar una cistoscopia para diagnosticar lesiones intrauretrales y vesicales. Los tratamientos propuestos son muy variados y de eficacia dispar, desde las topicaciones y la electrocirugía o la criocirugía, hasta el empleo de la tecnología láser. La prevención con el uso de protección durante el acto sexual así como la educación sexual son fundamentales. En los últimos 10 años se ha implementado el uso de la vacuna para el VPH en niñas con el fin de disminuir la incidencia de lesiones de alto grado y de cáncer de cuello uterino, pero su indicación en varones es menos clara y aún no ha sido consensuada. (AU)
Human papiloma virus (HPV) is one of the most common sexual transmitted diseases. It can affect the male genitalia, as well as the perianal and anal regions and multiple areas of the head and neck and otorhinolaryngological structures, as benign lesiones or as a promoter of malignant lesions. Benign male genitalia lesions are characterized mainly by verrucous lesions, although flat atypical lesions can be found, as well as the abscence of macroscopic visible lesions that in some cases can become evident using the acetic acid test. Lesion biopsy, its histological evaluation, and the determination of the existence and type of virus using PCR (Polymerase Chain Reaction) can confirm the diagnosis. In some cases is necessary to do a cistoscopy to diagnose intraurethral and vesical lesions. Proposed treatments are varied and with a wide range of efficacy, from topications to electro or cryosurgery, and the use of laser technology. Sexual education and the use of sexual protection are essential in prevention. In the last 10 years the use of VPH vaccine in girls was widely spread, in order to decrease the incidence of high grade lesions and cervix cancer. Its indication in male patients is less clear and not yet consented among specialists. (AU)
Assuntos
Humanos , Masculino , Infecções por Papillomavirus/terapia , Infecções do Sistema Genital/terapia , Podofilina/uso terapêutico , Podofilotoxina/uso terapêutico , Educação Sexual , Ácido Tricloroacético/uso terapêutico , Condiloma Acuminado/etiologia , Reação em Cadeia da Polimerase , Preservativos , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/tratamento farmacológico , Alphapapillomavirus/patogenicidade , Vacinas contra Papillomavirus/uso terapêutico , Terapia a Laser , Infecções do Sistema Genital/diagnóstico , Infecções do Sistema Genital/etiologia , Infecções do Sistema Genital/patologia , Infecções do Sistema Genital/tratamento farmacológico , Fluoruracila/administração & dosagem , Fluoruracila/uso terapêutico , Lidocaína/administração & dosagem , Lidocaína/uso terapêuticoRESUMO
Leptospirosis is a zoonotic disease of global importance, and has a worldwide distribution. Equine leptospirosis is commonly manifested by recurrent uveitis, reproductive disorders, as abortions, embryonic absorption, stillbirth and the birth of weak foals. The aim of this study was to verify the presence of Leptospira sp or its DNA in genital tract of mares with reproductive problems. A total of 38 mares with reproductive problems were studied. All the mares were sampled for blood (for serology), urine (for culturing and qPCR), vaginal fluid-VF and endometrial biopsy-EB (for culturing, qPCR and indirect immunofluorescence). PCRs products were sequenced for secY gene. Seventeen (44.7%) serum samples were reactive, predominantly against serogroups Australis (76.4%) and Pomona (23.6%). No positive culture was obtained, but DNA was detected by qPCR on urine samples (26.3%), VF (44.7%) and EB (18.4%) collected 2 months or longer following diagnosis of early fetal death and endometritis. Leptospira cell aggregations were visible by indirect immunofluorescence on 57.1% (4/7) EBs and 17.6% (3/17) VFs. A total of 18 amplicons showed interpretable sequences. Out of those 18 amplicons, 15 presented 100% of identity with the species L. interrogans (sv Bratislava and Pomona), while three were L. borgpertersenii. This study suggests the presence of leptospires in the uterus of mares with reproductive problems. Moreover, serology was shown not to be indicated for the diagnosis of presumptive Leptospira infection in early gestation. The most common agent of the genital infection in those mares was L. interrogans, most probably sg Australis.
Assuntos
Endometrite/veterinária , Doenças dos Cavalos/microbiologia , Doenças dos Cavalos/patologia , Leptospira/genética , Leptospirose/veterinária , Infecções do Sistema Genital/veterinária , Uveíte/veterinária , Aborto Animal/patologia , Animais , Líquidos Corporais/microbiologia , Endometrite/patologia , Feminino , Técnica Indireta de Fluorescência para Anticorpo/veterinária , Cavalos , Leptospirose/patologia , Reação em Cadeia da Polimerase/veterinária , Gravidez , Infecções do Sistema Genital/patologia , Uveíte/patologiaRESUMO
HIV and human papillomavirus (HPV) coinfection is increasing, especially in the anal canal (AC) and cervico-vaginal regions. We identified anal epithelium abnormalities related to high-risk HPV (HR-HPV) lesions in the lower genital tracts (LGTs) of HIV-positive women, described the HPV genotypes identified, and assessed the expression of E6/E7 oncogenes in coinfected patients. Ninety-eight women were enrolled in groups combining HIV status and presence or absence of HPV in the LGT. Anal and cervical smears were collected for cytology and HR-HPV assays using Cobas(®) and/or PapilloCheck(®). Samples with highly oncogenic HPV genotypes were confirmed by NucliSENS EasyQ(®). Forty-two HIV-positive (25-52; mean age 39.5) and 56 HIV-negative (18-58; mean age 35.7) patients were included. E2 and C1 groups presented AC alterations (P = 0.002); altered images for high-resolution anoscopy were higher in E1 and C2 (P < 0.001). Of the 29 women with alterations, 41.38% were HIV-negative and 58.62% were HIV-positive (P < 0.001). HIV-positive patients accounted for 29% of the anal high-grade squamous intraepithelial lesions (P = 0.015). The Cobas(®) positive result frequency was higher in three AC groups than in the other groups. There was variation in the number of HPV types in the cervico-vaginal samples among the study groups (P < 0.001). Anal cytology and anoscopy showed more altered findings in HIV-positive patients with HPV in the LGT. HR-HPV anal infections by various genotypes are common and are associated with cervical infections in HIV-positive patients. E6/E7 expression is apparently more common in the AC of HIV-positive women.
Assuntos
Coinfecção/virologia , Infecções por HIV/virologia , Infecções por Papillomavirus/virologia , Infecções do Sistema Genital/virologia , Adolescente , Adulto , Canal Anal/patologia , Canal Anal/virologia , Coinfecção/complicações , Coinfecção/patologia , Feminino , Genótipo , HIV/genética , HIV/isolamento & purificação , HIV/patogenicidade , Infecções por HIV/complicações , Infecções por HIV/genética , Infecções por HIV/patologia , Humanos , Pessoa de Meia-Idade , Proteínas Oncogênicas Virais/biossíntese , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/genética , Infecções por Papillomavirus/patologia , RNA Mensageiro/biossíntese , Proteínas Repressoras/biossíntese , Infecções do Sistema Genital/complicações , Infecções do Sistema Genital/genética , Infecções do Sistema Genital/patologia , Esfregaço VaginalRESUMO
Pathogenic microorganisms, such as Neisseria gonorrhoeae, have developed mechanisms to alter epithelial barriers in order to reach subepithelial tissues for host colonization. The aim of this study was to examine the effects of gonococci on cell junction complexes of genital epithelial cells of women. Polarized Ishikawa cells, a cell line derived from endometrial epithelium, were used for experimental infection. Infected cells displayed a spindle-like shape with an irregular distribution, indicating potential alteration of cell-cell contacts. Accordingly, analysis by confocal microscopy and cellular fractionation revealed that gonococci induced redistribution of the adherens junction proteins E-cadherin and its adapter protein ß-catenin from the membrane to a cytoplasmic pool, with no significant differences in protein levels. In contrast, gonococcal infection did not induce modification of either expression or distribution of the tight junction proteins Occludin and ZO-1. Similar results were observed for Fallopian tube epithelia. Interestingly, infected Ishikawa cells also showed an altered pattern of actin cytoskeleton, observed in the form of stress fibers across the cytoplasm, which in turn matched a strong alteration on the expression of fibronectin, an adhesive glycoprotein component of extracellular matrix. Interestingly, using western blotting, activation of the ERK pathway was detected after gonococcal infection while p38 pathway was not activated. All effects were pili and Opa independent. Altogether, results indicated that gonococcus, as a mechanism of pathogenesis, induced disruption of junction complexes with early detaching of E-cadherin and ß-catenin from the adherens junction complex, followed by a redistribution and reorganization of actin cytoskeleton and fibronectin within the extracellular matrix.